🩻MSK🩻 - Management of Fractures

Question 1

What are the steps for assessing damage in orthopaedics?

Answer 1

Look
Feel
Move X-ray

Question 2

What are the steps for repairing a fracture?

Answer 2

Reduce (realign fracture)
Hold - plaster, external fixator, internal fixator
Rehabilitate - usually 6 weeks later

Question 3

How is trauma approached in orthopaedics?

Answer 3

The fracture is usually the least important bit
Keep the patient alive first – ATLS
-Airway
-Breathing
-Circulation
-Disability (i.e. neurology)

Question 4

What should be looked for while assessing a fracture?

Answer 4

Pain
Swelling
Crepitus
Deformity
“Collateral damage” - nerves, vessels

Question 5

What are the investigations in orthopaedics?

Answer 5

X-ray (go-to in most cases)
CT sometimes indicated - make diagnosis or assess pattern
MRI if unsure

Question 6

How are fractures described on a radiograph?

Answer 6

Location: which bone and which part of bone?
Pieces: simple/multifragmentary?
Pattern: transverse/oblique/spiral
Displaced/undisplaced?
Translated/angulated?
X/Y/Z plane

Question 7

How can fractures be displaced?

Answer 7

Translation
Angulation
Rotation
Impaction

Question 8

Describe translation

Answer 8

Bone is translated and displaced either medial/lateral or dorsal/volar

Question 9

Describe angulation

Answer 9

Valgus/varus

Question 10

Describe rotation

Answer 10

Internal/external

Question 11

Describe impaction

Answer 11

Question 12

What are the two types of fracture healing?

Answer 12

Direct fracture healing
Indirect fracture healing

Question 13

Outline direct fracture healing

Answer 13

Anatomical reduction
Absolute stability/compression
No callus

Question 14

Outline indirect fracture healing

Answer 14

Sufficient reduction
Micromovement
Callus

Question 15

What is Wolff’s law?

Answer 15

Bone grows and remodels in response to the forces that are placed on it

Question 16

What are the steps of indirect fracture healing?

Answer 16

Inflammation - haematoma, release of cytokines, granulation tissue and blood vessel formation
Repair - Soft callus - type 2 collagen+cartilage, Hard callus - type 1 collagen+bone
Remodelling - Callus responds to activity, external forces, functional demands and growth
Excess bone is removed

Question 17

How long do fracture take to heal?

Answer 17

Usually 6 weeks
3-12 weeks depending on the site
Phalanges - 3 weeks
Metacarpals, distal radius - 4-6 weeks
Forearm, tibia - up to 10 weeks
Femur - 12 weeks

Question 18

How are fractures managed?

Answer 18

Reduce - closed, open
Hold - plaster/splint, internal or external fixation
Rehabilitate - early/late, weight bearing, physiotherapy

Question 19

What are the options for reduction?

Answer 19

Question 20

What type of fixture is this?

Answer 20

Plaster

Question 21

What type of fixture is this?

Answer 21

Internal intramedullary

Question 22

What type of fixture is this?

Answer 22

Internal extramedullary

Question 23

What type of fixation is this?

Answer 23

External monoplanar

Question 24

What type of fixation is this?

Answer 24

External multiplanar

Question 25

What are the types of fracture complications?

Answer 25

General (away from site) Specific (at site)

Question 26

What are some general fracture complications?

Answer 26

Fat embolus DVT Infection Prolonged immobility - UTI, chest infections, sores

Question 27

What are some specific fracture complications?

Answer 27

Neurovascular injury Muscle/tendon injury Non0union/mal-union Local infection Degenerative change (intraarticular) Reflex sympathetic dystrophy

Question 28

What factors affect fracture healing?

Answer 28

Mechanical environment - movement, forces Biological environment - blood supply, immune function, infection, nutrition

Question 29

What are the causes of fractured neck of femur?

Answer 29

Osteoporosis (older) Trauma (younger) Combination

Question 30

What should be identified in a history of someone resenting with a neck of femur fracture?

Answer 30

Age Comorbidity - respiratory, cardiovascular, diabetes, cancer Preinjury mobility - independent, shopping, walking, sports Social hx: relatives, stairs, etoh

Question 31

Describe the neck of femur anatomy

Answer 31

Question 32

Outline the different types of neck of femur fractures

Answer 32

Question 33

What is the majore risk of an intracapsular NoF fracture?

Answer 33

Blood supply is more likely to be compromised -AVN -Non-union

Question 34

How are extracapsular fractures managed?

Answer 34

Fixed

Question 35

When are intracapsular NoF fractures fixed or replaced

Answer 35

Question 36

What are the techniques to reduce a dislocated shoulder?

Answer 36

Question 37

Answer 37

Question 38

What are the management options for a distal radius fracture?

Answer 38

Question 39

Answer 39

Question 40

Answer 40

Question 41

Give an overview of tibial plateau fractures

Answer 41

Question 42

What are the management options for tibial plateau fracture?

Answer 42

Question 43

Answer 43

Question 44

What are the non-operative management options for an ankle fracture?

Answer 44

Question 45

What are the operative management options for an ankle fracture?

Answer 45